Difference Between a Pedorthist and Podiatrist

Dr. Ben Boudreau: [00:00:06] So hi, everyone, welcome to Humpday conversation number twenty-three with myself, Dr. Ben Boudreau and Dr. Clayton Roach from Roach Chiropractic Centre in Bedford, Nova Scotia, Canada. Today is a special episode. We feature a special guest from Comfort Orthotics and Bedford Dr. Roach. Would you like to take it away?

Dr. Clayton Roach: [00:00:29] Sure. So, everyone, this is Emily Conroy. So Emily works for orthotics in Bedford. Definitely, a relationship that has been ongoing for a while and a great one because it’s somewhere that I can send patients comfortably knowing that they were going to be taken care of and treated to the same level of professionalism that we try to do at Roach Chiropractic Centre. And it’s been something that we how long has it been Emily, like five, six, seven.

Emily Conroy: [00:01:02] Yes. 2015

Dr. Clayton Roach: [00:01:04] Twenty, fifteen. There you go. So we know you maybe you could introduce yourself where you’re from, how long you’ve been doing this, and walk right into the body of what we’re going to do.

Emily Conroy: [00:01:18] Yeah. So as I said, I’m Emily Conroy and I work for orthotics and the Sunnyside Mall just right down the road. And I have been a certified artist here since two thousand and twelve. And so to be a certified podiatrist, that means because everyone always wants to know what that is. You know, you’re at a party and you say that you’re a Pedorthis and they go, oh, OK.

Dr. Clayton Roach: [00:01:49] And then they just move on.

Emily Conroy: [00:01:50] Yeah, that’s right. Yeah. Anyway, so basically I specialize in orthotics and so I’ll do a good analysis and I’ll check out your shoes. And then depending on your condition, I work off of a prescription and depending on your condition, I will make an orthotic and suggest footwear to help to treat that.

Dr. Clayton Roach: [00:02:19] So Emily, why would somebody get into that field like what inspired you to to go there?

Emily Conroy: [00:02:24] Actually, funny enough, I required them myself. So I was a waitress trying to get through university and I knew I was going to be in the health field. I was in a lot of pain and trying to, you know, balance school and waitressing. And I thought that I was going to be a nutritionist, but went to one of the appointments myself and kind of looked around and said, hey, this checks all the boxes of what I would like to do. So I decided to switch gears, as many people do.

Dr. Clayton Roach: [00:03:02] And it’s all right. We call it a pivot, right? Yep. So let’s jump right into this. Emily, what’s the difference between a podorthist, and a podiatrist? I think some of our listeners would like to know that.

Emily Conroy: [00:03:15] Yeah. Yeah, for sure. There’s a long list, but the easy answer is that they cut into the dermal layer. So, yeah, I do not. They can take care of your ingrown toenails, your warts, your calluses, things like that.

Dr. Clayton Roach: [00:03:34] So are they too good for orthotics. They don’t touch your orthotics or what.

Emily Conroy: [00:03:38] No, I know they can, they can do orthotics as well. Yeah.

Dr. Clayton Roach: [00:03:43] Got it, got it, So they’re not attached to the knife. They can also do orthotics as well.

Emily Conroy: [00:03:45] Definitely, yeah. Yeah. Let’s make suggestions about footwear too.

Dr. Clayton Roach: [00:03:50] I’ll go to the next question, Ben, and you can go to the next one. So you know the things that I know way back when in two thousand and probably two thousand and six, seven, I just decided that it was going to be great for me to do orthotics. That’s probably ranking probably one or two of my decisions that were the worst decisions of my life because I realized I was in over my head. I know people are coming back and saying, oh, it hurts here and it hurts there. I’d send them back and the company would send them back.

And, you know, the way we’re doing them, it was just a headache for me to do. That’s when I said I got to do this because I’m in over my head. How do you guys do it when people go there in terms of the type of assessment that you do, how do you actually get to the point where somebody is bringing something home, putting it in there? How do you guys do that?

Emily Conroy: [00:04:38] Yeah, so after you do their gait analysis, which is watching them walk and determining what type of orthotic they require, which there are a few different types of orthotics as well, and we make different types out of different materials here because we have the luxury of having our own lab on-site as well until. Two years in June, we were using plaster and grinding that by either wrapping the foot or putting the foot in a home and pouring the plaster in there and grinding it and making it that way. But now we’re using a 3-D scanner. So it uses a 3-D volumetric scan.

And then that gets we would do a non-weight bearing and a weight-bearing scan and combine the two together and get an image from that, which then goes into a basically like a machine, like a 3-D printer. But the opposite, it can either grind out of a block that would be used for what we call an EVA or a cushioned orthotic. And then the different top covers are put onto that so we can determine if we want to use what’s called intrinsic posting. So if we needed some more heel support or arch support or whatnot, we can add that into it ourselves and then we just add the top cover on. That’s all enclosed in a machine now.

So all the grinding and whatnot is in a vacuum. Yeah. Or in that same machine, there’s a different type of block that we put in that grinds once again a mould instead of the plaster that we then put into a press that we can use the harder shell, which is called a poly, that would be used more for like an extreme pronator and that we still use we heat up the poly in an oven and make it that way with the press.

Dr. Clayton Roach: [00:06:42] So basically, you do the mould and then you put what’s comfortable on top, like what you see, like the sole, the material, That’s a little more intense than what I was doing when I was doing the orthotics.

Emily Conroy: [00:06:57] Yeah. Yeah. And you never had one choice of orthotic, the material that you were making where we have multiple choices at our disposal.

Dr. Clayton Roach: [00:07:06] Right.

Dr. Ben Boudreau: [00:07:06] Because this is completely different than what I learned from chiropractic college because we used to we could order our orthotics as well. But we don’t use those foam boxes. And you probably just cringe when you hear about it. But it’s one of those the ones we just put the foot in and makes the mould that way. Is that is that an accurate way of determining the correct orthotic, an individual? Is that still.

Emily Conroy: [00:07:35] You can. Yeah, for sure. It all just depends on the the user, how you’re not cramming the foot into their semi weight bearing and weight bearing. Right. There’s different ways that you can you can get the impression from that as well.

Dr. Clayton Roach: [00:07:52] Right. Because I always when I was using those boxes, I was like, I could use the same box, same patient, probably come up with like ten different orthotics, like it was just put the foot like. That’s right. And not doing enough. You just don’t get good at I guess that’s what it was.

Emily Conroy: [00:08:04] Yeah. For sure.

Dr. Ben Boudreau: [00:08:06] And so depending on the type, you know, type of condition that a patient might present with, you know, was definitely going to determine the type of orthotics that they get. Are there specific types of conditions that people come in with that, you know, this is a, you know, a patient suited for this type of orthotic versus another? And what are these conditions?

Emily Conroy: [00:08:29] Yeah, and it’s sometimes it’s the condition, but it’s also the person’s biomechanics as well. And then their work. You know what? They’re going to be wearing the orthotic in for their daily activities and things like that, that it all plays a factor. And so did you want me to give you an example

Dr. Clayton Roach: [00:08:52] What would be the top three conditions, the

Emily Conroy: [00:08:56] Plantar fasciitis first? Sure. Unfortunately, which I’m guessing that most people have heard of, and then probably bunions would be the next condition that I see. And maybe like just a general pes planus or a metatarsalgia, which is just a very generalized diagnosis. But then when you take more into it, you find out exactly what’s going on.

Dr. Ben Boudreau: [00:09:29] Pes planus for all of us are just flat feet. Yeah, that was a trick question mean, would you rather treat flat feet or people that have too much of an arch?

Would You Rather?

Emily Conroy: [00:09:40] Oh, I thought you’re going to say, ah, I would rather treat flat feet, I guess

Dr. Clayton Roach: [00:09:48] Is it easier to correct for

Emily Conroy: [00:09:50] I see a lot more of flat feet. Yeah, I find that with. With high arches, there’s usually a lot more going on.

Dr Clayton Roach: [00:10:01] Yeah, for sure.

Emily Conroy: [00:10:02] And that’s like an extreme high. We’re talking about just not like a regular church that people come in. They say, oh, I have really high arches and then but you know, each to their own like we said

Dr. Ben Boudreau: [00:10:16] And so when it comes to the different activities like we’re talking about the environment. Right. Plays a huge factor in, OK, well, what kind of authority do they need? Right. So would you give let’s just say I’m a runner and I’m working construction and then I have my slippers at home without using the same orthotic and the three or what I need maybe a custom for each of my shoes?

Emily Conroy: [00:10:41] Well, sometimes it comes down to money as well. Right. So you you may have to use the you may have plantar fasciitis because you’re a runner and you’re construction and you may have to and you can only afford one and you have to use it all because you have plantar fasciitis and you need that orthotic under your plate at all times. So I got to make that work and I will.

Dr. Clayton Roach: [00:11:01] Yeah. So do you find people sometimes will do like one year with their plan? They’ll buy a pair of orthotics and then the following year the one they bought is a one-year-old, but they’ll go with the new one so that they can fit in other shoes or not. I think for me, some of the complaints that I got from patients, they keep taking their orthotics out of one shoe and putting them into another. Yeah.

Emily Conroy: [00:11:23] For sure. OK.

Breaking in Your Orthotic and the Kinetic Chain

Dr. Clayton Roach: [00:11:26] Cool. So here’s one of the issues that I have, and I’ll be honest with you, one of the things that I see a lot and I’ve never seen with you guys, so obviously I’m not talking about you guys, but I find a lot of times people have a hard time with their thoughts because the Dorothea’s was overzealous with the amount of correction that they were making. And the patient comes back to me, says, it feels like I’m stepping on a golf ball. Right. Or they overcorrected the arch. And now they have knee pain.

So what’s your mindset when you’ve got a patient in front of you so that they have an enjoyable experience with their orthotics? What’s some of the advice you can give and what is to some of the things that clinically that you try to incorporate so that that doesn’t help? Because I haven’t seen it with you. So I’m just wondering what you do differently.

Emily Conroy: [00:12:13] Yeah, definitely. The break in process is huge for that. So when they first if it’s a new patient and that’s our first time getting orthotics, they usually feel that golfball and they’re kind of surprised looking at me, telling me that they feel like they’re walking on the outside of their foot on the lateral edges, and they’re wondering when that’s ever going to go away. But I have on the back of my business card, I actually have a break in process written on there. And because it’s that much of a regimen that you need to go through it, you know, there’s people once again, you talked about that that runner construction type who just says, oh, no, no, that’s not me. I’m I’m too busy.

I can’t stop and take them out after an hour, the first day and then two hours the next. But I drill it that that needs to happen. Or you are going to cause issues like knee pain or back pain, hip pain, things like that. And so I also offer free adjustments. So if it is something that is bothering you that you need to come back and get it adjusted. We follow up. We do a call and follow up and make sure. But also when you get your orthotics, it’s not just the one-shot deal. You come back and pick them up and try them on with me and walk around and make sure that they’re comfortable as well. It should never be painful.

Dr. Clayton Roach: [00:13:50] So let me ask you this, Emily, how important is it to you to understand the kinetic chain in the sense of really what is happening in there? Do you have arthritis in the knee, have arthritis in the hip? Is it important for you to understand the rest of the picture when you’re looking at the feet?

Emily Conroy: [00:14:09] 100%, it’s important for alignment I deal a lot with limb length discrepancy as well. I still see polio patients who will have one leg extremely shorter than the other. We do. We do build up on footwear as well to accommodate for that, but it’s not just the kinetic, which, of course, you guys can attest to quite a bit. But then there’s also, you know, there are a lot of diabetic patients, unfortunately, but also has to do with their compliance as well. Maybe there’s some more mental, you know, and and you need to take it all all in and and just make sure that the orthotics aren’t going to sit in the closet that they’re going to be used.

Dr. Clayton Roach: [00:15:08] And you get the buyer’s remorse. Right.

Dr. Ben Boudreau: [00:15:12] Make sure that they love the product and that they understand that it’s a whole picture. Right. So it’s not just us chiropractors out here that are telling you to consider your health from all the different aspects of it, all the pillars. But also when it comes to any other structure in your body, you have to understand how to sort of maintaining that structure in its environment. So everyone who is on here makes sure that you give us a like and show us your support for Emily, who’s doing a great job telling us a lot about your feet. So make sure you show her some love right now by making and sharing these conversations.

Dr. Clayton Roach: [00:15:47] Remember the rule, right? We’ve got a guest, so everybody is going to share the stuff. So that’s the rule. I was just going to say, just like with us, when we’re working with patients, there’s always that. Right? There’s always that that chance. So are moving things or trying to get things back to where they need to be. There’s always that chance that it’s going to be a little bit painful in the beginning. How long? And I guess it depends on everybody, but what’s the average length of time that it normally takes for a good orthotic to break in? And they start feeling the impacts of the eye.

Emily Conroy: [00:16:20] Usually about two weeks is what we say, that you progress about an hour each day and it’s usually about two weeks that you can wear them full time. But like you say, every person is different and maybe they won’t be able to wear them a little bit each day. And they need to take four weeks. And we talk about that when we when we pick them up and make it work for their lifestyle.

How to Get Your Orthotic

Dr. Clayton Roach: [00:16:46] Emily, when you talked about the different thoughts for different lifestyles you guys do, I know when I was doing orthotics, they had a big three-quarter link for women that still wore high heels. Yeah, you guys still do those, like the three-quarter length.

Emily Conroy: [00:17:02] We have three quarter length, but I deter away from them honestly.

Dr. Clayton Roach: [00:17:08] They were a nightmare because they always slid down like it was terrible. Have you thought about that because?

Emily Conroy: [00:17:14] Yeah. And a three quarter length I wouldn’t put in a high heel anyway if I was going to make them a three quarter length for me.

Dr. Clayton Roach: [00:17:23] Sorry for everybody that I put in the three quarter length

Emily Conroy: [00:17:27] To quarter length for me is more like a poly. So once a hard shell orthotic with a deep heel cut that’s going to control like a child’s hypermobile foot. And so more of children who are in the growing stages so that their toes aren’t hanging over the end of the orthotic as they’re growing. So they get a little bit more like them. Yeah. Yeah. That’s where I applied a little bit more.

Dr. Clayton Roach: [00:17:57] So speaking of a deep heel cup, what do you do for people that have and I think you’ll talk about that for people that have a heel spur, talking about plantar fasciitis, it goes on untreated and all of a sudden you’ve got a heel spur. What do you do about that?

Emily Conroy: [00:18:10] Yeah, so usually with plantar fasciitis, you would have more of a cushion orthotic. And so with that, if it’s if you already have the orthotic made, because when I was talking about this new fancy technology we have, we can actually do the accommodation for it built right in. But if you already have the orthotic made and you developed a heel spur or you just got your x rays back or you’ve gone to your car factor and they’ve diagnosed you or whatnot, then you can take a dremel and actually cut a hole in the bottom of the orthotics. So it’ll allow it to sit down and kind of have its own little home there to offload it.

Dr. Clayton Roach: [00:18:53] That is awesome. Yeah, it’s almost like a donut. People sit on when they heard their sacrum.

Dr. Ben Boudreau: [00:19:00] So we have a question from the audience. Are all of your patient’s referrals or do you also take walk-ins? I know this is a question for a couple of my patients that I referred. So do they need a referral from a medical doctor or can they just walk on in?

Emily Conroy: [00:19:17] Yeah. So my licensing requires a prescription, a referral from a medical doctor to see them. I can’t do it just off the street. And usually, if you’re going through insurance, you need one every time that you’re going to claim through your insurance. I just need one for life to see a patient can it be from a chiropractor. It can be from a chiropractor for me to see them. It cannot be from a chiropractor usually for their insurance to cover it, it has to be from an M.D.

Dr. Clayton Roach: [00:19:55] Ok. Both the both to get covered for the assessment and then to get covered for the orthotic if they need an orthotic

Emily Conroy: [00:20:02] Yeah, which is actually all rolled into one for us, OK.

Dr. Clayton Roach: [00:20:08] Yeah. Because the medical doctor really understands what they need for their feet.

Emily Conroy: [00:20:14] Yeah, that’s why they send them usually, right?

Dr. Clayton Roach: [00:20:20] So, yeah, that’s a soapbox from chiropractors not being able to be part of that referral process. But anyway, we’ll leave that for another day.

Emily Conroy: [00:20:31] That’s why they’re called general practitioners.

Dr. Ben Boudreau: [00:20:34] That’s right. Right.

Emily Conroy: [00:20:35] We’re the specialists.

Do You Need Orthotics for Life?

Dr. Ben Boudreau: [00:20:36] Well, another comment here for you, Emily, is Emily is so patient and caring. That is a great one. Now, Kathy says, how long do you usually use an orthotic before, And I know this is depending on the patient would try to give averages here, how long you usually use an orthotic before you should go back to see if the correction has made or do you permanently have to wear your orthotic And again, this comes down to patient specific, but I’ll let Emily answer this. This one.

Emily Conroy: [00:21:09] Yeah. So I mean, I think of an orthotic more of like a brace. It’s never going to permanently correct you. So it’s only something that you wear to offload. Like if you have a flat foot, it’s not going to create an arch out of nowhere. Unfortunately, it’s only going to give you that support that you require for whatever ailment that you have. Now, if it’s something like Achilles tendonitis that you’ve developed and you require the orthotic to help heal you, and then after that, you no longer require it, that’s fine. But usually, there’s a reason why you’ve developed Achilles tendonitis and the orthotic may be good. Let’s just stay in your work shoe or in your runner as a preventative as well.

Dr. Clayton Roach: [00:22:03] So great answer. Yeah, yeah, I agree with that. And so just to parley with that question. We had a question at one point, we did like an open question thing and that somebody asked, are we born with flat feet? We all know that we do like we’re born with flat feet and that the arts develop. What would be their hereditary factors or the reason we develop flat feet at a very young age other than we don’t we see them a lot when we get older. But what would be some of the reasons that an adolescent would not develop an arch on the foot? And is there a way to bring that back? Or is that person stuck wearing the orthotic

Emily Conroy: [00:22:43] That’s a debate, an ongoing debate among the professionals. So there are people who believe that if you get it early enough, then you have that support there that they will create. But most are on the belief that it is genetic and what the cards are out there, the cards that you’ve been dealt is eventually what is going to happen. So your earlier question of why are you born with flat feet? So you you’re born hyper mobile and then your bones ossify, and so you have that. That look of that over pronated when you’re younger and then you may create the the straighter not pronated look when you get through puberty, right.

Dr. Clayton Roach: [00:23:36] And I just call it fortunate or unfortunate, but because our feet are bones are held together by ligaments once they’re stretched. They don’t really come back. So what you’re saying about the authority being a brace and supporting that right. Probably for life because the ligaments don’t have the ability to contract again. Yeah, yeah, yeah.

Dr. Ben Boudreau: [00:23:57] So, Emily, what is your take on my roommate in chiropractic college is a big runner and he was using this product and correct me if I’m wrong, Superfeet. And it’s more of a progressive orthotic. Correct. Whether it’s correct me if I’m wrong, it starts with a higher arch. And then they progressed to lower arches as you move through the program. Correct me if I’m wrong, but I thought that that was really cool because it sort of gave it that support in the beginning that it really needed. And then as the arch strengthened or got better, they took some away. What is your opinion on progressive arches arch support

Emily Conroy: [00:24:39] There’s something out there that’s an over the counter that you can entertain the interchange, the arches just to fit your own arch Superfeet, to my knowledge, isn’t one of them. The Superfeet that I know is just like a harder over the counter that is well structured around the heel cup and the arch. And they have different ones for like skates and and wider feet and whatnot. But the interchanging arch is good, but the progression is once again debatable. I can see why it would be beneficial for a runner, because if he was wearing it and like his everyday shoe, he may want a higher one and then may want a lower arch when he’s running and putting more pressure on the arch. That depends.

Dr. Ben Boudreau: [00:25:35] And that’s a great point that I didn’t know a lot about either is yeah, when you’re not doing as much activity, you might want a higher arch. And when you’re doing a little bit more like running, like you’re saying, you might want to lower Arch because it’s taking a lot more of a beating with every step.

Emily Conroy: [00:25:50] Yeah, some people just can’t handle a higher arch when they’re when they’re running. So you may want to swap it out. It’s the only thing I can think of with that.

Dr. Clayton Roach: [00:25:59] So, Emily, on that, though, clinically speaking, how would you account for the difference in the arch height for somebody who wants one for work, somebody who wants one for running the. How would you? Guesstimate.

Emily Conroy: [00:26:11] Yeah, so it will go back again to what we’re treating, OK? If it was that that sticky plantar fasciitis once again, which with runners usually it is, then you want that arch support to offload the heel pain. You want to want to keep the arch supported as much as you can. So you’re not straining the fascia

Dr. Clayton Roach: [00:26:36] That’s awesome. And to all our listeners who have learned something, if you’ve learned one thing tonight. Give us a little bit of thumb’s up here in the hearts. I think Emily’s doing a great job and actually, we’re learning a lot. That’s one of the reasons, selfishly, that we want to bring Emily along, because we get these questions that, you know, we somewhat normally we somewhat generalize. And so it’s great to have this avenue to be able to get some professional answers and not grant answers like that. And I might have to give because we’re not sure. So thank you for that.

Dr. Ben Boudreau: [00:27:10] And it’s also about making with Emily here and working together. Thank you for the love. It’s about being able to make the connection between what we do as chiropractors and why we need the help of professionals like you were when it comes to the field where we have these really complex cases and we’re not things just aren’t moving as quickly as we want them to know. Right. Not moving in the right direction. Having a properly fitted, professionally done orthotic and having professionals look at the feet from the perspective that you have in the philosophy mix as well with what we do as chiropractors. We just want to see more health professionals work together to find the right solutions for their patients as well. Yeah, exactly. And that’s why we do this.

Dr. Clayton Roach: [00:28:07] And I mean, to be honest, when we take a look at human beings are bipedal, so we have to accept ground force every day. Right. So we’re walking or running. We’re standing. For us as chiropractors to make changes to the spine and. Not take that into account would be totally ridiculous. You’re never going to fix low back pain or where the person has so many flat feet that they’re pronated and, you know, they’re tibias internally rotating all of a sudden and they have no hip movement or the back is just the effect, not the cause. You have to look at the entire thing and make sure that you’re addressing what needs to be addressed and to try to fix it back and then ignore the feed goes against the premise of taking care of the cause of the problem.

Dr. Ben Boudreau: [00:28:56] So we have another good question. And I think this will play with a lot of people who maybe have that medical doctor who’s who doesn’t look into the feet as much. They say if I know that I can get a prescription from my family doctor, but he or she isn’t quite sure what to write on the prescription. Where can I go to have my foot properly assessed and properly diagnosed?

Dr. Clayton Roach: [00:29:26] So you can that is a good question

Emily Conroy: [00:29:28] that is a really good question and you can come and see a podiatrist You don’t need a referral to come and see one of the lovely podiatrists that we have here at the clinics.

Dr. Ben Boudreau: [00:29:42] Exactly, and that’s a perfect question, or the perfect answer.

Dr. Clayton Roach: [00:29:47] So I’m confused Emily, so if they go directly to a podiatrist, does MSI cover for that?

Emily Conroy: [00:29:54] No.

Dr. Clayton Roach: [00:29:56] OK, so they would pay out of their pocket to get assessed by a podiatrist and would then be able to write the prescription. For the orthotic, yeah,

Emily Conroy: [00:30:08] Ok, but generally an M.D. should be able to write something

Dr. Clayton Roach: [00:30:15] And the prescription can be kind of generic, right assessment needed for foot pain or back pain or whatever.

Emily Conroy: [00:30:23] Usually you want or if it’s going to be covered by insurance, you want it to have a medical diagnosis of the foot.

Dr. Ben Boudreau: [00:30:34] Ok, so that answers the other question that we have here, where is the prescription written to the clinician to assess or does it list the orthotic But either way, regardless of what happens, the clinician at the podiatry clinic is going to make the assessment and make the proper recommendations correct.

Morton’s Neuroma

Emily Conroy: [00:30:52] Are you talking about me or are you talking about the podiatrist

Dr. Ben Boudreau: [00:30:56] You or the podiatrist?

Emily Conroy: [00:30:57] I mean, either of us are definitely going to do the right thing for sure. Yeah, exactly

Dr. Clayton Roach: [00:31:03] But the prescriptions should have a diagnosis of the feet. So pes planus flat feet

Emily Conroy: [00:31:08] 100%, even if they have super high arches

Dr. Ben Boudreau: [00:31:10] Fasciitis,

Emily Conroy: [00:31:11] If they have super high arches and it says, you know, orthotics for flat feet, I will still give you the right orthotic. I promise.

Dr. Clayton Roach: [00:31:17] You’re not necessarily going to go by the diagnosis on a prescription. You’re going to do an assessment.

Emily Conroy: [00:31:23] That’s right. Yeah.

Dr. Ben Boudreau: [00:31:24] And that is why Emily is getting the most beautiful comments in the comment section today. It says Emily is the best of what she does, hands or feet down.

Dr. Clayton Roach: [00:31:39] And one of the patients that I sent to you guys said, I have been to a podiatrist in your clinic. And he was excellent. So great there.

Dr. Ben Boudreau: [00:31:45] So one of the big differences would be obviously one of our questions would have been what’s the difference between the Costco brand and having a customer thought, OK, done. It’s the quality of the clinicians that you’re meeting and the amount of effort that they’re putting into giving you the highest quality product that they can offer. So whenever you’re going and just like we talk about this with our vitamins and supplements at the clinic, it’s all about doing the research and finding the right quality product and you’ll get the quality results. Yes. And so that’s why it’s always worth investing in that in a good quality orthotic. Yeah.

Dr. Clayton Roach: [00:32:23] Guys, we’re going to continue to chat with them. But as you guys have questions, go ahead and comment or ask your questions in the comments section. This is a very special time where you get one on one time with a specialist who’s willing to stay after hours for us and you guys. And definitely worth a share, by the way. And so go ahead Ben.

Dr. Ben Boudreau: [00:32:47] I was going to say, what was one thing or a few things that you wish that people knew about foot health. What is one thing that you wish people knew about foot health?

Emily Conroy: [00:33:03] I wish that people did more proactive than reactive with foot health. I guess with. With their not so much with their orthotics, but with their footwear, because I just find that I see them at their worst points, and if they had a better fitting and more structured footwear, not necessarily that they have to spend a ton of money on it. If they had just gone to a place that had fit them properly, to begin with, and have given them a little bit more guidance then they wouldn’t be in the position that they are now.

Dr. Clayton Roach: [00:33:52] Very good question. Question. Good answer. Let’s talk about footwear Emily. And I think that’s obviously the elephant in the room because, you know, you go to a store and it’s, you know, buy one, gets the other one for a toonie and whatever, and they get to my clinic and they’re busting over the side of the shoe and. What’s your general opinion on footwear in terms of, you know, and maybe we can kind of categorize it as new people that have wider feet? Mm hmm. What is one brand that’s known to offer solutions for wider feet? I see a lot of new balance have the opportunity to go wide So maybe you can touch base on that.

Emily Conroy: [00:34:38] So that’s definitely the one that I would have said. And I mean, we’re talking about sneakers here. Obviously, the best tip that we have here that I think everyone should take is to take the unsold out of the shoe that you’re purchasing and put it on the ground and put your foot on it. And you don’t necessarily have to stand up. Just look down and make sure that the size of your foot overhanging and you have about a thumbnail from the end of your longest toe, and that’s your best way of getting the proper fit.

Because I don’t know if you guys remember the Brannock device that we used to have in the store. It was like a metal machine that you would you know, it would tell you that you were a size nine and a half inch and whatnot, and then that was your size across the board. That isn’t very consistent nowadays because a new balance to soft made an A6. They all have very different ideas of what a nine and a half D is. And you’re probably a 2E, not a D just saying. So taking that insole out and putting your foot on it, that needs to fill the inside of the shoe. So, therefore, hanging over the side.

Dr. Ben Boudreau: [00:35:53] So here’s my biggest realization. I was at a store. I won’t name it, but anyway, I was at a store and I was buying a pair of shoes and the guys know what they’re doing anyway. So for my whole life, I was wearing. Eight, eight and a half, eight and a half. Right, I walk over there with a nine and a half and the guys like this are really what you need. So I nearly trip out of the store because I wasn’t using his canoes and but I could never, ever go back to eight or eight and a half.

Because you don’t realize it when you’re weight-bearing, how much your toes go. Old school and probably one of the biggest causes of hammer tools too. Right. And people were too short of shoes and the toes start to curl at the end. So that was my biggest realization. So it’s funny you mention that as your first comment, making sure you get the right size shoe.

Emily Conroy: [00:36:43] Yes.

Dr. Ben Boudreau: [00:36:43] Yeah, yeah. And I was about to say the same thing when I went to another store. I mean, great store because they helped me find out my correct size for four runs. Right. So for years I was running in a size 10 and I started ramping up my mileage and I’d end up at the end of my run with blue feet. So my my my toenails were hitting the end of my toe box. And so I had gone into the store and he had said, you know what to look. If you took your shoes out and said, you know what? You’re a size 11 and a half. Yeah. And half in the A6. So every brand will have different sizes, of course. But then also, depending on what you’re doing, you may need a different size of shoe, right?

Emily Conroy: [00:37:26] Yeah, exactly.

Dr. Ben Boudreau: [00:37:28] Definitely. If you’re considering that, take that into consideration when you’re choosing good footwear. So it wasn’t just a blue colour of the insole coming off, though. That might have been in there, too, though. That’s what happens when you shop sneakers and. Yeah, there isn’t a big picture. Well, I have a question about Morten’s neuroma. So is this one of those is that one of those situations where you would put a like a jelly pad in that area where the aroma is? Or is there something special that you would do?

Dr. Clayton Roach: [00:38:03] Yeah, we actually have what’s called a neuroma pad. And so depending on once again, it can be different for different individuals. Sometimes it’s just a nuisance for them and other people can’t even walk around and propel forward with the pain. And so they may need a much larger pad because the role of the pad is quite small. It looks so metatarsal. Pat is like a small dome that’s near the front of the foot, just right here, just behind. The metatarsals here to fill in that gap, everyone thinks about this search here, the medial arch on the side of your foot. But then there’s a lateral arch.

But this is your metatarsals here and they need quite a bit of a curve as well. And so when you get that narrow, McCain, it’s you. It’s because of the nerves pinching in between here and so adding that pad here behind it will help to offload it. But then, as I said, other people get the pain when they go to push forward here. And so you may need to add in a rocker sole shoe too. So then when you’re going to step forward, you’re not making this motion anymore. The shoe is doing that motion for you.

Dr. Clayton Roach: [00:39:36] Foot is so complicated. Oh, my God.

Dr. Clayton Roach: [00:39:39] a quarter of the bones in your body. All in your feet.

Dr. Ben Boudreau: [00:39:43] Amazing how we use our feet all day long. So I was about to say Morten’s neuroma is No joke. I mean, from what I remember from studying a little bit over foot care. It feels like you’re walking on marbles and correct me if I’m wrong or walking on pebbles. Pebbles in your shoes.

Emily Conroy: [00:39:59] Yeah. Sometimes it can feel like that as well. Yeah. Sometimes shooting nerve pain as well. Yeah. Yeah.

The Problem with Flip Flops

Dr. Clayton Roach: [00:40:08] So I remember one of the tests. You just squeeze the foot. Right, and the pain just goes shooting question. With summer coming, what are your thoughts on flip flops and also about the specific brand flops?

Emily Conroy: [00:40:21] Yeah. So actually talking about Morton’s neuroma or anything that affects the forefoot with a flip flop then. Now, this is a flip flop, not a fit flop. So anything there where it is not attached at the ankle itself, then your toes are doing this motion to keep the shoe on. And so if you have any forefoot issues, then it’s going to aggravate that more. So the fit flop has some arch support to it.

So I have a lot of people who have told me that they tried that as a shower shoe to give them some arch support when they were at the pool and the gyms were open or when they were showering to offload their plantar fasciitis just because they knew they couldn’t be barefoot. But it’s definitely not an all-day shoe If you’re in foot pain, it also breaks down really fast.

Dr. Clayton Roach: [00:41:28] One thing that I’ve noticed the with the flip flops that have just the tong, what happens is I find like when the when they’re in the swing phase, they bring their toes up to keep the sand along. So or the flip flop on and they get like the tendonitis on top of the foot. Right. And I see that all the time and it’s brutally painful. They don’t know why. And I’m like, why you’re wearing them today. So this is why am I wrong.

Emily Conroy: [00:41:54] No, you’re not wrong at all. It’s just it’s just aggravating All the.

Dr. Clayton Roach: [00:42:00] Sheeth on top, right? Yeah.

Dr. Ben Boudreau: [00:42:03] So last week, we had a conversation about bunions and valgus and we were talking about little things that people could do and we were talking a little bit about spacers and more specifically, the space between the first and second toe. Is that is that recommended in the literature with your in your profession? And is does that help with that valgus?

Emily Conroy: [00:42:33] Yeah, I mean, it all valgus is is saying that the helix, this part of the toe is going away from the midline, so space there is going to hold it over whether you’re putting it there because it’s crowding this toe and the nail is rubbing on it and it’s causing issues there. But as soon as you take that space out, the toe is going to go right back over again. It’s not going to correct it. The only thing that’s going to correct that Vargus is going to be surgery. So if you have a bunion and you have pain in that joint and your toe, your helix is valgus, your toe is going over and you find that you have comfort when you bring it over here wear that spacer as much as you want.

But it sometimes causes more sharing and discomfort in between the toes and having the orthotic there once again is going to cause a lot of people to pronate on to that first ray, where that bunion is and put a lot of pressure on it that way. And so having the orthotic there is going to increase the arch and take the pressure off and then you can have your spacer there as well. If you’d like

Dr. Clayton Roach: [00:44:00] multipronged approach there, Ben. Yeah, I’d love that. But it’s a brutal surgery. Like I’ve had a few patients said it was worse than labor. Like they don’t they didn’t like that surgery at all. I had a patient say I’d rather have a hip replacement any day and not have that surgery

Emily Conroy: [00:44:18] And they’ll get one done and they won’t go back for the other one.

Dr. Clayton Roach: [00:44:20] They’ll never go for another, not the one that I’m thinking about. Yeah. So just to confirm such a suggestion for a sandal would be something that has a strap around the heel.

Emily Conroy: [00:44:32] Yes.

Dr. Clayton Roach: [00:44:34] Yes, so what about Birkenstocks, what’s the deal with Birkenstocks?

Emily Conroy: [00:44:37] Yes, I mean, a Birkenstock is very rigid all the way through, so it had it right away. It has a good structure through the arch. I don’t think we’ve talked about that yet. When we were talking about footwear and making sure it fits properly, you also have to make sure that it doesn’t bend in the arch. A lot of shoes do remember this whole barefoot, minimalist craze that started a few years ago. Unfortunately, along with that came taking the shank. So I’m looking up because I have shoes right here taking the shank and the structure out of the middle of the shoe so you can take and bend the whole thing right in the middle.

And so you want to make sure that you’ve got some good structure in the middle of your shoe, which the Birkenstock has a lot of sandals. You can take a flip flop and just bend it and put it in your pocket. And so luckily a burkhas that and some of them just have that. That thong, that part that just attaches at the toes, but a lot of them now have straps that come farther back towards the ankle and so your toes don’t have to do that move to keep it on and they do move.

Dr. Clayton Roach: [00:45:54] And correct me if I’m wrong with some of the Birkenstocks, you can do a cutout and put the orthotic in there right is that Birkenstock of does that or other.

Dr. Clayton Roach: [00:46:01] No, Birkenstock doesn’t have removable flatbeds. OK. All right. Some of those do and most of the Naots do. And there’s a Cambrian and now is a new orthopedic that’s come out and it looks a lot like those sandals and they have completely removable footbeds.

Dr. Clayton Roach: [00:46:20] Ok, there you go. I think we answer that question, can you buy a sandal you can put in orthotic and we just answer that, OK?

Emily Conroy: [00:46:27] We have a whole lot of them.

Dr. Ben Boudreau: [00:46:28] A lot of them come from orthotics. So, guys, thumbs up hearts, please. And please, please share this episode. This is amazing information that without Emily volunteering to do this, you would have to take time out of your own schedule, get a prescription, do everything to be able to get a hold of somebody like Emily and take time out of your schedule. So thank you, Emily, for doing this. Ben anything else?

Dr. Ben Boudreau: [00:46:56] Well, I was just going to say that I thought. That the minimalist running craze where people were running barefoot, right, they were saying that this is a healthier way to run. This is the way people were meant to be. Mm-hmm. What’s the response from the foot community? What are people actually saying with our minimalist runners? Are they healthier? Are they do they have better feet than those that are conventionally running

Emily Conroy: [00:47:26] That if you can do that and not have any foot or knee or back pain? You give er.

Dr. Ben Boudreau: [00:47:33] Yeah.

Emily Conroy: [00:47:34] So you have that pain. I’ll help you out and I’ll send thme your way

Dr. Clayton Roach: [00:47:39] yeah Their back won’t be too far, too far behind. How often do you replace your orthotics?

Emily Conroy: [00:47:52] About every two years. And I mean, that’s are you. It’s kind of like a car tire. Right. So it depends on how often you’re wearing them and how many miles you’re putting on them

Dr. Clayton Roach: [00:48:07] So that it’s OK. Minimalist running as a source of my Morton’s neuroma. That’s what somebody said. And the shoes. Do you require an appointment at your clinic right now to get advice on the shoes you sell? I’m assuming no.

Emily Conroy: [00:48:24] No, I mean, we’re talking about covid locked down, so

Dr. Clayton Roach: [00:48:30] That might be what she meant. OK, sorry.

Emily Conroy: [00:48:33] Right. We have the doors locked and you come and ring the doorbell and they will help you out best you can. OK, what they are saying, people for footwear right now. OK, cool.

Dr. Clayton Roach: [00:48:47] Get to know. Um.

Dr. Ben Boudreau: [00:48:50] So I think this was I think that this was a great conversation for those of you who have really enjoyed this conversation, please like and share and show them some love for sure for definitely giving some of her time tonight to talk to you guys live on Facebook. So, Emily, we definitely thank you so much for being on this live episode with us. This is our twenty-third episode doing this. Twenty-three weeks in a row. And we just love being able to communicate with people in our community and reaching out, knowing that there are great practitioners down the road that have a great philosophy of really being out there and wanting to give back to their patients and their community. So thank you so much for being with us this evening.

Dr. Clayton Roach: [00:49:35] Before before we went life or talking to Emily that. It’s a shame that chiropractors stick with chiropractors and physios, sick with physios and, you know, I think one thing that I hear from my patients the most is we wish everybody would talk about everybody and work together. And this was innately one of our goals with Humpday conversations is to have this conversation that put everybody in the same conversation, so to speak, so everybody can get the answers that they need. Because I think the more quality questions you ask, the more you know all the answers you get.

And that basically gives you better diagnoses, better treatment options, better everything. So that was the goal. I’m just reading through real quick here. People are chiming in for questions. Me too. But everybody enjoys this. Everybody saying thank you so much. Dear Lord, this was my favourite interview, by the way. I learned a lot, which is great. And I think our patients are really appreciating that. So in respect of your time, I know you’re going to head out. Thank you so much from the bottom of our hearts.

It’s been great being able to refer people to you and knowing that they’re going to be taken care of. So thank you so much. Appreciate it. If you’re listening to us on YouTube, make sure you subscribe to YouTube and do this gal a favour and make sure that you share this episode. This is her only way of being paid. She’s not being paid tonight. And so thank you. Thank you so much. Thank you.

Dr. Ben Boudreau: [00:51:05] Just to let everybody know you can find Emily at Comfort Orthotics in the Sunnyside Mall in Bedford, Nova Scotia, Canada. And so if you are looking for a really nicely made pair of orthotics made with care and love, you can find Emily Conroy at Comfort Orthotics in Bedford and Sunnyside Mall.

Dr. Clayton Roach: [00:51:29] And thank you so much, guys. Really appreciate everything. And we look forward to it. You’re welcome. Comfort with always saying thanks for having Emily on into life. It’s our pleasure. So from whom? The conversation Ben. And I would like to wish you a good night. And we’ll be here again next week. On Wednesday at nine o’clock, we’ll come up with a topic like we always do and next month looks forward to another interview. And again, thank you very much, Emily. Thank you. So you guys.

Dr. Clayton Roach: [00:52:01] What’s up? Listen, if you like this episode, you’ll probably like the other ones, chances are pretty good. So here’s what you need to do. You need to like us and follow us on Facebook. Following means, you get notified when these two guys are alive. Next, family, friends, you need to share these episodes because you never know. You might help them because they need this information as well. And guys, if you ever miss an episode, make sure you subscribe to us on YouTube.

Dr. Ben Boudreau: [00:52:21] That way, you can watch the episode over and over and over again. Guys, we love you and appreciate you. Take care.